Neurophysiological identification of position-induced neurologic injury during anterior cervical spine surgery.

Abstract

This study was a retrospective review of 3,806 patients who underwent anterior cervical spine surgery with multi-modality neurophysiological monitoring consisting of transcranial electric motor evoked potentials, somatosensory evoked potentials and spontaneous electromyography between 1999-2003. The objectives of this study were twofold: (1) to evaluate the role of transcranial electric motor evoked potential tceMEP and ulnar nerve somatosensory evoked potential (SSEP) monitoring for identifying impending position-related stretch brachial plexopathy, peripheral nerve entrapment/compression or spinal cord compression and (2) to estimate the point-prevalence of impending neurologic injury secondary to surgical positioning effects. Sixty-nine of 3,806 patients (1.8% showed intraoperative evidence of impending neurologic injury secondary to positioning, prompting interventional repositioning of the patient. The brachial plexus was the site of evolving injury in 65% of these 69 cases. Impending brachial plexopathy was most commonly noted immediately following shoulder taping and the application of counter-traction. Brachial plexus stretch upon neck extension for optimal surgical access and visualization was second in frequency-of-occurrence. Evolving traction injury to the ulnar nerve attributed to tightly-wrapped or malpositioned arms was observed in 16% of alerted cases, whereas evolving spinal cord injury following neck extension accounted for an additional 19%. This study highlights the role of tceMEP and ulnar nerve SSEP monitoring for detecting emerging peripheral nerve injury secondary to positioning in preparation for and during anterior cervical spine surgery.

• Authors: Daniel M Schwartz, Anthony K Sestokas, Alan S Hilibrand, Alexander R Vaccaro, Bikash Bose, Mark Li, Todd J Albert
• Journal: Journal of clinical monitoring and computing (J Clin Monit Comput) Vol. 20 Issue 6 Pg. 437-44 (Dec 2006) ISSN: 1387-1307 [Print] Netherlands
• PMID: 16960753 (Publication Type: Evaluation Study, Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Cervical Vertebrae (surgery)
• Evoked Potentials, Motor
• Evoked Potentials, Somatosensory
• Female
• Humans
• Intraoperative Complications (diagnosis, etiology)
• Male
• Middle Aged
• Monitoring, Intraoperative (methods)
• Neurosurgical Procedures (adverse effects)
• Posture
• Retrospective Studies
• Spinal Cord Injuries (diagnosis, etiology, physiopathology)
• Spinal Nerve Roots (injuries, physiopathology)